Provider Demographics
NPI:1609166495
Name:BH LABS LLC
Entity type:Organization
Organization Name:BH LABS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:POMPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-962-6465
Mailing Address - Street 1:960 ARTHUR GODFREY ROAD #320
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140
Mailing Address - Country:US
Mailing Address - Phone:305-962-6465
Mailing Address - Fax:
Practice Address - Street 1:960 ARTHUR GODFREY RD STE 320
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-3348
Practice Address - Country:US
Practice Address - Phone:305-962-6465
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-13
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL10000104729291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOS8431OtherMEDICAL LICENSE
FLME86213OtherMEDICAL LICENSE
E84317Medicare UPIN